Monitoring Devices Help Elderly Stay at Home

In the wee hours of July 14, Elizabeth Roach, a 70-year-old widow, got out of bed and went to the living room of her Virginia ranch home. She sat in her favorite chair for 15 minutes, then returned to bed.

She rose again shortly after 6, went to the kitchen, plugged in the coffee pot, showered and took her weight and blood pressure. Throughout the morning, she moved back and forth between the kitchen and the living room. She opened her medicine cabinet at 12:21 and closed it at 12:22. Immediately afterward, she opened the refrigerator door for almost three minutes. At 1:36, she opened the kitchen door and went outside.

All this information — including her exact weight (126 pounds) and blood pressure reading (139/98) — was transmitted via the Internet to her 44-year-old son, Michael Murdock, who reviewed it from his home office in suburban Denver.

All was normal — meaning all was well.

“Right now she’s not home,” Mr. Murdock said. That he deduced because the sensors he had installed throughout his mother’s home told him that the kitchen door — which leads outside — had not been reopened since 1:36, more than an hour earlier. The opening of the medicine cabinet midday confirmed to him that his mother had taken her medicine. And he was satisfied that she had eaten lunch because the refrigerator door was open more than just a few seconds.

In the general scheme of life, parents are the ones who keep tabs on the children. But now, a raft of new technology is making it possible for adult children to monitor to a stunningly precise degree the daily movements and habits of their aging parents.

The purpose is to provide enough supervision to make it possible for elderly people to stay in their homes rather than move to an assisted-living facility or nursing home — a goal almost universally embraced as both emotionally and financially desirable. With that in mind, a vast spectrum of companies, from giants like General Electric to start-ups like iReminder of Westfield, N.J., which has developed a system to notify families if loved ones haven’t taken their medicine, are looking for a piece of the market of families with an aging relative.

Many of the systems are godsends for families. But, as with any parent-child relationship, all loving intentions can be tempered by issues of control, role-reversal, guilt and a little deception — enough loaded stuff to fill a psychology syllabus. For just as the current population of adults in their 30s and 40s have built a reputation for being a generation of hyper-involved, hovering parents to their own children, they now have the tools to micro-manage their aging mothers and fathers as well.

Wendy A. Rogers, a psychology professor at Georgia Tech, who has studied such systems and seniors’ reactions to them, recalled a man who went into high alert when a sensor system showed a high level of activity in a room of his mother’s home. He called her to find out what was wrong — and it turned out that she had decided to paint the sunroom.

“I think the critical question is: Is this something the parent wants?” said Nancy K. Schlossberg, a counseling psychologist and professor emerita at the University of Maryland. She compared monitoring technology for elderly people to the infamous “nanny cams” — hidden cameras some parents use to spy on their children’s baby sitters. “Big Brother is watching you — there’s something about it that’s very offensive,” she said.

The decision, she said, must ultimately be made by the aging parent. “It has to be negotiated with the parents,” Dr. Schlossberg said. “You want to keep the relationship co-equal. If it’s not an agreement with the parent, it can be a very destructive thing.”

The system Mr. Murdock persuaded his mother to install is called GrandCare, produced by a company of the same name based in West Bend, Wis. It allows families to place movement sensors throughout a house. Information — about when doors were opened, what time a person got into and out of bed, whether there’s been any movement in a room for a certain time period — is sent out via e-mail, text message or voice mail. He said his GrandCare system cost $8,000 to install — about as much as two months at the local assisted-living facility, Mr. Murdock said — plus monthly fees of about $75. The company says that costs vary depending on what features a client chooses.

In addition to giving him peace of mind that his mother is fine, the system helps assuage that midlife sense of guilt. “I have a large amount of guilt,” Mr. Murdock admitted. “I’m really far away. I’m not helping to take care of her, to mow her lawn, to be a good son.”

His mother, Mrs. Roach, was nervous at first when her son brought up the idea of using the system. “I didn’t want to be invaded,” she said. “I didn’t understand the system and was concerned about privacy.” Now that it’s in place, she said, she’s changed her mind: “I was all wrong. I’m not feeling like I’m being watched all day.” And she really enjoys the system’s feature that lets her play games and receive photos and messages from her children and grandchildren. (She never learned to use e-mail.)

Mrs. Roach has no major health issues that require the kind of watching she is getting, and oddly enough, that is the ideal scenario. Elinor Ginzler, senior vice president for livable communities at AARP, said it’s best to discuss using such technology long before a parent’s health has slipped to a point where she might actually need it. “You frame it that way: ‘We’re so happy that things are going so well. We want to make sure to keep it that way. Let’s talk about what we can do to make sure.’ ”

What often follows is pushback. After all, this is not a generation known for its ease with technology.

“My parents’ first reaction to technology is, ’Get it away from me,’ ” said Rachel Meyers, 45, of Brooklyn, whose father, an 80-year-old retired math professor, put at the top of his course syllabus each year: “Do Not E-mail Me.” When her mother, who just turned 84 and lives with her husband in Minneapolis, developed kidney disease, Rachel and her far-flung siblings worried about how to ensure that she was taking the complicated regimen of pills needed daily for her condition.

Their father was not going to be a reliable enforcer. “My father is going to be in his own cave reading a math book with his socks and sandals,” Ms. Meyers laughed. “He is not that guy.”

Through her work as director of community initiatives at the Metropolitan Jewish Health System in Brooklyn, Ms. Meyers learned about a medication management system called MedMinder. It is basically a computerized pillbox. The correct daily dosages of her mother’s 10 different medications are arranged in boxes. When it is time to take them, the pillbox beeps and flashes. If she takes them, Ms. Meyers gets a phone call in Brooklyn saying, essentially, Mom took her pills. Her siblings, including a brother who lives in Australia, get e-mail notifications.

But if her mother doesn’t take the pills within a two-hour window, the system starts nagging. It calls her. It flashes and beeps. Then Ms. Meyers gets a phone call in New York with a message saying her mother missed her dose. “So that’s been interesting,” Ms. Meyers said. “I can call and say, ‘Hey Mom, have you taken your medicine?’ She’ll say, ‘No, I’m on my way.’ I’ll say ‘Do it as a favor for me and take it while we’re on the phone.’ She’ll take it.”

Usually it all works out. But “what does get us into hairy, difficult emotional ground,” Ms. Meyers said, is when her mother’s daily routine changes and her children neglect to reprogram the pillbox to keep up with the shift. For example, as the dialysis began taking a toll, her mother began sleeping later in the morning, but the MedMinder still expected her to take her pills at 7.

“The machine is beeping and she’s not up yet,” Ms. Meyers said. “We get stuck in our own busy lives” and forget to reprogram it. “She says, ’I don’t want it any more.’ Now we’re in a defensive place.”

However, in an interview, Ms. Meyers’s mother, Harriet Meyers, said she had come to appreciate the contraption. “At first I was rebellious. I said, ‘Look, I’m lining up my pills, Rachel.’ I said, ‘I know what I’m doing.’ ” But now she looks at it differently. “I decided to try and now I’m hooked.”

Several academic studies have been undertaken to see just where the line between loving watchfulness and over-intrusion might be drawn. Researchers at Georgia Tech have created an experimental house (called the Aware Home) outfitted with various sensors and motion detectors as well as systems that provide support for medication and memory. They brought in older adults to see how they felt about the devices. “They were quite positive about the idea,” said Ms. Rogers, who is a director of the university’s Human Factors and Aging Laboratory. But the key, she said, is control. The older person is much more amenable if he or she “can control who has access to the information and what information they have access to,” she said.

Other research suggests that having the monitors in place may be enough to give family members peace of mind, and that they are less likely than one might expect to spend time poring over the information. Kelly Caine, a researcher at Indiana University, is just completing a study that found that for all the handwringing over whether to install monitoring technology, the people who received the information from such systems “rarely checked in on the older adults using the monitoring technology more than once per day.” The findings are preliminary, cautioned Ms. Caine, the principal research scientist at the university’s Center for Strategic Health Information Provisioning.

Adult children who call parents to check up on them have learned to be careful about how they phrase their questions. “I personally don’t make it so that I’m watching,” Mr. Murdock said. “I don’t say, ‘Mom, I was looking and you didn’t do this.’ I say, ‘Mom, are you O.K.? I noticed you didn’t take your medicine.’ It’s a balancing act, but it’s an easy conversation. It’s not like I’m calling every day saying, ‘Did you do this or did you do that?’ ”

Other families have also found that the systems reduce the need for nagging conversations. Ray Joss, 91, of Flushing, Queens, has been using a sensor-based system called QuietCare that she found through Selfhelp, a social services company in New York that helps seniors use technology to allow them to live independently. She says that she and her son, who lives in New Jersey, don’t have to dwell on her well-being in conversations because the monitoring system has already let him know how she is. “We talk about other things rather than just how I feel. He doesn’t have to ask me.”

Despite their increasing familiarity with the technology, many elderly people draw the line at cameras.

Susan Oertle has been using a wireless monitoring system called BeClose to check on her aunt, who was recently widowed and had no children of her own. Though the 83-year-old woman recently broke her hip and suffers from a lung condition that compromises her breathing, she is still fiercely independent and likes to stay up till 1:30 a.m. Thanks to wireless sensors in her aunt’s bed, Ms. Oertle can roll over in the middle of the night and notice an e-mail message flashing on her phone reassuring her that her aunt went to sleep. But enough is enough. If there had been cameras to monitor her, Ms. Oertle said, “I think she would have had a bird.”

Courtesy of NYTimes


COBRA Confusion

Bill Bregar thought he was doing everything right. With his former employer’s health insurance due to run out in May 2009, he believed that his visit with his wife to the Social Security office to sign up for Medicare would be routine. He was wrong. They were told they wouldn’t be able to get Medicare coverage until July 2010. Suddenly, in their late 60s, they faced the prospect of 13 months without health insurance. “My reaction was disbelief,” he recalls. “My wife went into shock.”

Bregar, a former software engineer from Lake Oswego, Ore., and his wife, Ruth, had run afoul of an obscure rule that is little understood by Medicare beneficiaries, employers, health insurance companies and even some Social Security and Medicare officials. And their experience has led directly to their congressman, Rep. Kurt Schrader, D-Ore., proposing legislation to have the rule changed.

Obscure rule hurts beneficiaries
Under current law, working Americans with employer health coverage can postpone signing up for Medicare until after 65. When they retire, accept a buyout or are laid off, they then get an eight-month special enrollment period to sign up for Medicare Part B (which covers doctors visits and other outpatient services) immediately and without penalty.

But many people in these circumstances are able to extend their employer coverage for a year or two under a 1986 law known as COBRA, which is what Bregar did.

What they may not realize is that waiting until their COBRA coverage expires to enroll in Part B disqualifies them from the eight-month grace period. Instead, they must wait to sign up during open enrollment, from Jan. 1 to March 31 each year, and their coverage won’t begin until the following July. They also get hit with a late penalty, an extra charge added permanently to their Part B premiums.

The COBRA catch
Social Security officials explain that under the law, people can postpone signing up for Part B without penalty only while they have group health insurance provided by an employer for whom they or their spouses are still working. Therefore, time on COBRA—used after employment has ended—does not entitle them to special enrollment.

Although this rule is 24 years old, in recent months AARP and other consumer help organizations have both seen a significant uptick in the number of calls complaining about it.

The Medicare Rights Center, which tracks calls involving Part B enrollment problems, reports that this year more than 21 percent of these relate to the COBRA issue. The timing may be due to the fact that when the economic recession hit in 2008, more older Americans lost their jobs and opted for COBRA coverage without thinking to sign up for Part B—and are only now facing the consequences. Nobody yet knows how many people are affected.

Confusion, even among experts
“It’s clear from the number and types of calls we get on our hotlines that there is a lot of confusion about how Medicare works with COBRA,” says Joe Baker, president of the Medicare Rights Center. “Not only are individuals confused, but employers are as well, and the price of the confusion can be devastating for some.”

Yet the crucial Medicare regulation barring a special enrollment period for people whose COBRA coverage is ending is rarely publicized. It is not mentioned in the Department of Labor’s guidance for people considering COBRA. It is mentioned briefly on page 24 of the official handbook, “Medicare & You 2010”—but without any warning of a delay in Part B coverage. It isn’t included in Social Security’s general website information on enrolling in Medicare or in its frequently-asked-questions section—though entering “COBRA” into the site’s search engine leads to an explanation.

But many people don’t go to these sources. Instead, they rely on information from their employers, their insurance company or Social Security officials. Bregar, who accepted a voluntary retirement package from the Hewlett Packard Company in 2007, consulted all three. On an earlier visit to the local Social Security office when he turned 65, he says the official told him he didn’t need to sign up for Part B until his employer insurance ended. “What he didn’t say,” Bregar adds, was that this wasn’t true “if I stopped working at any time even if my health insurance were still in effect.”

After the bombshell landed, Bregar repeatedly called Social Security. Among some 15 conversations with officials, he says, “two of them told me exactly the same wrong information as I was given in the first place.”

But one suggested he apply for “equitable relief.” This little-known option allows Social Security to investigate cases and reverse decisions if it finds an official has given faulty information. Bregar wrote a letter applying for relief and took it down to the office. “The lady there said: ‘Well, I’m happy to forward this on, but I can tell you I’ve been here for 26 years and I’ve only seen one case resolved in favor of the applicant,’ ” he recalls.

At that point, Bregar called the office of his congressman, Schrader. His staff, who’d never heard of the rule either, became interested. Their calls resulted in a “congressional inquiry” label attached to the Bregars’ Social Security file. Meanwhile the couple, frantically trying to find insurance, discovered that only one policy—costing around $1,700 a month—was available to them. On the day they were due to sign up, Bregar received a call from Social Security. He says the official said simply: “When do you want your Medicare insurance to begin?” He said: “Next week?” “Done,” she replied. The power of a congressional inquiry had paid off.

Unlucky victims caught in the trap
Many others in the same situation are not so lucky. Harvey Fine, of Woodstock, Ga., had planned to retire from his job as a packaging company executive upon reaching age 70 in October. But last summer he was laid off and now he and his wife, Lucille, are covered under COBRA until December. He, too, was stunned to discover last month that they’d fallen into the unforeseen trap and would have to wait until next July for Medicare. Everyone had told him that COBRA was simply an extension of his employer’s group coverage—“same policy, same card, same everything,” he says. “The hidden point to me was this eight-month window. You lose out unless you know these things.”

Fine, too, complained to Social Security that he’d been given wrong information, but at a review he was denied because he couldn’t remember the name of the official he’d visited a year ago. There was a record of his visit, but “they said the person didn’t enter anything into my file,” he recalls. The agency confirms that an investigation cannot be opened unless the applicant can provide the name of the official and the date and place of the conversation. And an applicant making a formal appeal is unlikely to succeed, because ignorance of the law is not a defense.

Fine wonders why he is being penalized when, by taking COBRA for 18 months, he has actually saved Medicare money. “There seems no logic in this rule,” he says. The confusion is compounded by the fact that Medicare Part D, the prescription drug benefit, has a different rule: People whose COBRA benefits expire are allowed a two-month special enrollment to sign up with a drug plan without penalty.

No Medicare for months
Many older Americans who fall into the Part B-COBRA trap aren’t so concerned about the late penalty, but say the prospect of no insurance for months is frightening.

Like most others, Fine’s insurance options after COBRA ends are limited. With a history of diabetes, high blood pressure and high cholesterol—which his current medications keep in check—he is unlikely to find individual coverage. He isn’t eligible for insurance under the new health care law’s high-risk pools that accept people with preexisting medical conditions, because to qualify people must have been uninsured for at least six months.

He may be able to get coverage under another law that allows people who have had continuous coverage from an employer plan and COBRA for at least 18 months to buy insurance regardless of preexisting conditions, but this is usually very expensive. Fine is exploring all possibilities, but the process “is like Russian roulette,” he says. “My worst case scenario is to bite the bullet and dig into whatever savings I have.”

A proposed change in the law
It was Bregar who suggested to Schrader that the law should be changed.

Schrader agreed.

His bill, entitled the Medicare Enrollment Protection Act of 2010, proposes to allow people a special enrollment period of eight months after COBRA benefits run out to sign up for Medicare immediately and without penalty.

The bill would also create continuous enrollment for people who miss their Part B deadlines for other reasons. They, too, would get coverage the month after they applied, but would pay an appropriate late penalty. That’s to prevent people gaming the system and deliberately failing to sign up and pay premiums until they have serious medical issues, Schrader says. “Seniors have earned these benefits and need to be covered,” he adds.

Courtesy of AARP

Limit Salt Intake: Avoid Processed Foods

The average person in the U.S. consumes 3,500 milligrams of sodium a day. That’s equivalent to almost 9 grams of salt, or nearly 2 teaspoonfuls—way more than the 2,300 milligrams per day suggested by the Dietary Guidelines for Americans.

But the majority of excess salt, or 77%, isn’t spooned into your food—it comes from processed foods. The FDA recently announced a plan to gradually scale back on salt in processed foods, which may be the end of the line for super salty products.

In the meantime, keep an eye out for excess sodium and adjust your intake accordingly. Check out these hidden salt traps you can find lurking in the grocery store.

Kellogg’s Raisin Bran
Though this cereal contains only 15% of your daily sodium recommendation, it has more than double the sodium of some other cereals. Cheerios contains 190 milligrams, GoLean has 85 milligrams, and Special K Protein Plus contains 147 milligrams per one-cup serving.

Classico Caramelized Onion and Roasted Garlic Pasta Sauce
One serving of this sauce contains more than 20% of your salt intake for the day. Instead, opt for more classic varieties—Classico’s Tomato & Basil has 310 milligrams—or even make your own.

Kellogg’s Eggo Buttermilk Pancakes
Eat these pancakes for breakfast, and you’ve consumed 25% of your sodium for the day. And if you add in 1/4 cup Kellogg’s Buttery syrup, you add in 90 more milligrams, for a total of 670 milligrams—one-third of your daily sodium. Swap them for two Eggo waffles and you save 160 milligrams.

MorningStar Farms Chipotle Black Bean Burger
Usually veggie and black bean burgers are healthier alternatives to beef burgers. Even though these black bean burgers are only 210 calories, they contain nearly one-third of your daily sodium intake. A President’s Choice Backyard Burger contains 480 milligrams of sodium, and Amy’s Organics makes a low-sodium veggie burger with only 250 milligrams.

Kraft Singles
Whip up a grilled cheese sandwich with two Kraft singles and two slices of white bread (Arnold Country White Bread contains 180 milligrams per slice), and you could be consuming close to 1,000 milligrams of sodium.

Pepperidge Farm Pumpernickel Bread
Even if you don’t add any meat, cheese, or condiments, two slices of this pumpernickel bread will cost you 380 milligrams of sodium, or 15% of your daily total.

Perdue Short Cuts Carved Chicken Breast, Southwestern Style Chicken Strips
Four ounces of uncooked chicken breast contains 45 milligrams of sodium, so if you’re craving Southwestern-style chicken, it’s better to make your own than to eat this precooked variety.

Lender’s Whole Grain Plain Bagel
This bagel has the same amount of sodium as a serving of Slim Jims, but somehow you don’t expect a bagel to run neck and neck with a salty-tasting snack. And if you add a smear of cream cheese (between 100 to 200 milligrams of sodium per ounce), you’ll have a breakfast that’s nearly one-third of your daily salt intake.

Duncan Hines Moist Deluxe Devil’s Food Cake
Think sweets come salt-free? No way! One slice of this cake equals 15% of your daily intake, and dark chocolate frosting adds another 120 milligrams.

Otis Spunkmeyer Harvest Bran Muffin
Muffins seem harmless, but this healthy-sounding breakfast contains more than 20% of your sodium for the day.

Birds Eye Asian Vegetables in Sesame Ginger Sauce
Any smart shopper knows to bypass the frozen vegetables with cheese sauce, but this label is deceptive. The product may contain only 60 calories per serving, but it packs in more than 25% of your daily sodium. Opt to make your own stir-fry using low-sodium soy sauce instead.

Courtesy of

Scallops in Buttery Wine Sauce

This simple, classic combination highlights the delicate flavors of fresh scallops without overpowering them. Make it a simply elegant meal by paring them with asparagus and crumbled feta. Be sure to pat the scallops dry with a paper towel to remove any excess moisture before searing. This step ensures a nicely browned exterior.

1 1/2 pounds large sea scallops
1 tablespoon olive oil
1/2 cup dry white wine
1 1/2 teaspoons chopped fresh tarragon
1/4 teaspoon salt
1 tablespoon butter
Freshly ground black pepper (optional)

Pat scallops dry with paper towels. Heat oil in a large nonstick skillet over medium-high heat; add scallops. Cook 3 minutes on each side or until done. Transfer scallops to a serving platter; keep warm. Add white wine, tarragon, and salt to pan, scraping pan to loosen browned bits. Boil 1 minute. Remove from heat; add butter, stirring until butter melts. Pour sauce over scallops. Sprinkle with pepper, if desired; serve immediately.

Courtesy of Cooking Light

Steps Forward, and Backward, in Treating Diabetes by Dan Hurley

Catch the headline in The Times? “Warning Urged on Diabetes Pill,” it stated. “F.D.A. Proposes a Strongly Worded Label on Hazards of Heart Disease to User.” But it didn’t run this week, regarding the drug Avandia. The headline appeared almost exactly 35 years ago, on July 4, 1975, about a different drug for Type 2 diabetes that went through a strikingly similar controversy: tolbutamide. To this day, it and similar drugs for diabetes, the sulfonylureas, are still sold with a warning on “increased risk of cardiovascular mortality.”

The more things change in diabetes treatments, it seems, the more they stay the same. About four months after that old headline ran, during my freshman semester at college, I went to the hospital one afternoon for nausea, figuring I had a bad case of flu, and learned I had Type 1 (juvenile) diabetes.

Not to worry, the doctor told me. In fact, he said, I was lucky. The old glass syringes that diabetics used to need were a thing of the past. “Now we have disposable plastic syringes,” he said. (Oh, joy.) Better yet, he said, a cure was coming any day. Pancreas transplants had been done in mice!

I was still waiting for that cure in 1983, when another Times article began by quoting a physician speaking to a group of Type 1 diabetics: “In your lifetime, you’re going to be cured.”

These promised cures and assorted breakthroughs turn out to have a long history. On May 6, 1923, The Times published an article by Dr. Joseph Collins under the headline: “Diabetes, Dreaded Disease, Yields to New Gland Cure; Previous Claims for Insulin Confirmed at Meeting of American Physicians.”

That was actually the third time the newspaper used the word “cure” in the headline of an article about insulin’s discovery. And it was easy to understand the excitement. Until the 20th century, diabetes was considered a rare disease: in 1866, for example, the reported death rate in New York City was 1.4 per 100,000 residents. By 1923, the rate had jumped to 22.9 per 100,000, and the idea of a cure was welcome indeed.

But as many knew even then, insulin wasn’t a cure. Sure, it instantly saved the lives of people like me, with Type 1 diabetes; but it was a lifelong treatment, carrying the ever-present risk of causing blood-sugar levels to fall dangerously low.

Moreover, it soon became apparent that insulin didn’t prevent long-term complications, and it didn’t work nearly so well in older, heavier people — those with the far more common version of the disease, Type 2.

So imperfect was this so-called cure that the death rate attributed to diabetes actually went up. From 22.9 deaths per 100,000 New York City residents in 1923, the rate reached 29 per 100,000 in 1932 and soared to 44.4 in 1947 — nearly double the rate before insulin’s discovery. (The nationwide death rate is now 24.2 for Types 1 and 2 combined, and diabetes is the sixth leading cause of death; in New York City, the rate is 18 per 100,000, and it is the fifth leading cause of death.)

By the 21st century, the promise of a cure for Type 1 seemed to have finally been fulfilled with the development of the Edmonton protocol, a method for transplanting insulin-producing beta cells into the pancreas. It looked for a few years like the real deal — until most of the transplanted cells stopped producing insulin in most recipients, and the patients had to resume taking injections.

For Type 2 diabetes, the drug industry has now produced some two dozen types of medications, even as the disease has become about 50 percent more widespread in the United States than it was in 2001, with some 23.6 million diabetics, or nearly 8 percent of the population, according to the Centers for Disease Control and Prevention.

Type 1 diabetes is rising sharply, too. A large and growing body of scientific literature suggests that it is now being diagnosed at about double the rate as in the 1980s, about five times the rate of the 1950s, and perhaps 10 times the rate of a century ago. Researchers at the C.D.C. tell me that it continues increasing by about 3 percent a year.

It hasn’t all been bad news for diabetes treatments, of course. With so many more people affected by the disease, the decline in death rates since the 1940s is reassuring.

Home blood-sugar tests weren’t even available when I learned I was diabetic, and they’ve since helped millions manage their disease better. Insulin pumps and continuous glucose monitors for Type 1 have also greatly improved control of blood-sugar levels. And an old standby for Type 2, metformin, appears to be one of the few drugs for the disease that actually prevents the loss of insulin-producing beta cells in the pancreas.

But given the disappointing history of many other treatments, some researchers have set out to find ways to prevent both forms of diabetes in the first place.

“Whatever the trigger is, we want to find it,” Dr. Judith Fradkin, director of the diabetes division at the National Institute of Diabetes and Digestive and Kidney Diseases, told me. Regarding Type 1, she said: “The rates are rising. Something has to be behind it. We need to find it. If we find it, that has tremendous implications for prevention.”

Studies are now under way to test promising strategies, whether by removing cow’s-milk formula from infants’ diet or by giving a vaccine that calms the immune system’s attack on the pancreas.

For Type 2, ambitious public-health campaigns are likewise seeking to prevent the disease’s spread, by lifting techniques from the anti-cigarette playbook: taxing unhealthy foods and drinks, limiting their availability and alerting consumers to their risks with calorie counts on chain restaurants’ menus (a strategy pioneered in New York City and recently passed as part of the national health-care legislation).

Nearly 35 years after my diagnosis, I’m doing fine, without any complications — and still without any cure. But these days, my hopes have shifted from cure to prevention, so that my 14-year-old daughter and the millions of others at risk never get diabetes in the first place.

Courtesy of the NYTimes

Vitamin D Also Linked to Memory

Older men and women with low levels of vitamin D are nearly four times as likely to have problems with their memory, attention and logic, according to a new study presented this week at the Alzheimer’s Association’s International Conference in Honolulu. The study suggests a link between vitamin D deficiency and an increased risk of cognitive decline and dementia later in life. Interest in the “sunshine” vitamin has intensified recently as more and more research suggests it may play a role in a variety of diseases associated with aging, including heart disease, some cancers and diabetes.

Researchers led by David Llewellyn, a neuropsychologist at the University of Exeter in England, analyzed information about 3,325 adults age 65 and older in a study that was carefully designed to reflect America’s older population. Their report documents a relationship between low vitamin D levels and impaired thinking. They found that the likelihood of performing poorly on tests of memory and attention was about 42 percent higher in people who were vitamin D deficient and nearly 400 percent higher in people who were severely deficient.

Vitamin D is called the sunshine vitamin for good reason. The body needs only a few minutes of direct sunlight to generate amounts that are more than adequate. With age, however, skin becomes less efficient at producing vitamin D, so older adults are particularly vulnerable to this deficiency. Vitamin D levels can be measured by blood tests.

“The majority of older adults in the U.S. have deficient levels of vitamin D,” says Llewellyn, “and our findings suggest that this may increase the risk of new cognitive problems and dementia.”

Researchers have begun to think vitamin D is important to brain health by protecting the blood supply to the brain, Llewellyn said at the Alzheimer’s conference Sunday.

“We also suspect that vitamin D may help to clear toxins from the brain,” Llewellyn says, helping to break down amyloid-beta protein, the substance that is thought to play a role in causing Alzheimer’s disease.

A related report published Monday by some of the same researchers in the Archives of Internal Medicine had similar results. Analyzing data from another study that attempts to identify factors that lead to disability, Llewellyn and colleagues found that older men and women with low levels of vitamin D don’t do as well on tests of reasoning, learning and memory as those with higher levels. Participants completed interviews about their health history, had medical examinations, provided blood samples and took tests measuring thinking skills at the start of the study and again after three years and six years.

The analysis reveals that compared with participants who had sufficient vitamin D levels, those who were severely deficient experienced a substantial decline in thinking and in executive function—the ability to organize thoughts, make decisions and plan ahead. The authors say that the link between vitamin D deficiency and cognitive decline persisted even after adjusting for diet, health and other factors.

“This work suggests an additional potential benefit to maintaining adequate vitamin D levels,” says Edward Giovannucci, M.D., of Harvard’s School of Public Health, who was not involved in the report, “and it’s important that deficiency is treated, as low levels are detrimental to overall health.” However, he adds, further study is needed to clarify the role of vitamin D in brain function.

Courtesy of AARP

New Rules for Preventative Screenings

The White House on Wednesday issued new rules requiring health insurance companies to provide free coverage for dozens of screenings, laboratory tests and other types of preventive care. The new requirements promise significant benefits for consumers — if they take advantage of the services that should now be more readily available and affordable.

In general, the government said, Americans use preventive services at about half the rate recommended by doctors and public health experts.

The rules will eliminate co-payments, deductibles and other charges for blood pressure, diabetes and cholesterol tests; many cancer screenings; routine vaccinations; prenatal care; and regular wellness visits for infants and children.

Other services that must be offered at no charge include counseling to help people stop smoking; screening and counseling for obesity; and tests for infection with the virus that causes AIDS.

“Getting rid of cost-sharing is a long-overdue step in the right direction,” said Kenneth E. Thorpe, a professor of health policy at Emory University in Atlanta. “But we will have to do a major public education campaign to get people to take advantage of these clinical preventive services.”

The rules stipulate that no co-payments can be charged for tests and screenings recommended by the United States Preventive Services Task Force, an independent panel of scientific experts. The rules apply to new health plans that begin coverage after Sept. 23 and to existing health plans that make significant changes after that date. The administration said the requirements could increase premiums by 1.5 percent, on average.

Kathleen Sebelius, the secretary of health and human services, said the rules would extend benefits to 31 million people in new employer-sponsored plans and 10 million people in new individual plans next year.

In many cases, insurers will be allowed to charge for goods and services needed to treat a condition detected in a screening. For example, consumers can receive free screenings for depression and high cholesterol, but they might be charged co-payments for antidepressants and cholesterol-lowering drugs.

In some cases, the task force has specified how frequently a service, like colonoscopy, should be performed. If the guidelines are silent, the rules say, an insurer may use “reasonable medical management techniques to determine the frequency” of services.

The administration is working on a supplemental list of free preventive services for women.

The Planned Parenthood Federation of America says insurance plans should be required to cover contraceptives without co-payments.

“For women, what could be more basic preventive care than birth control?” asked Cecile Richards, the president of Planned Parenthood.

Other services that must be provided without charge include genetic counseling for certain women with a family history of breast cancer, counseling to promote breast-feeding by new mothers and screening for osteoporosis in older women.

Ms. Sebelius said that 100,000 deaths could be averted each year if doctors and patients effectively used five services: colorectal and breast cancer screening, flu vaccines and counseling on smoking cessation and on aspirin therapy to prevent heart disease.

Courtesy of NYTimes